1. Baseline Findings Jan 2011 VimoSEWA Arogya Sanshodan

2. Today’s Presentation Overview of Swasthya Sanshodan project Summary of baseline findings Analysis plan Your feedback on data, analysis and use

3. Action Research – Why? VimoSEWA claims 2007-9 Primary illness 40% of claims Hysterectomy top claim for rural women, avg age 37 Effectiveness of health education Longstanding SEWA activity, in different forms Recent studies show impact on neonatal mortality Can it work for primary care and hysterectomy?

4. Research Questions Can health education reduce unnecessary hospitalisation for diarrhea and fever? Incidence Expenditure Health seeking behaviour What are the drivers of hysterectomy? How does education impact on knowledge and response to hysterectomy and gynecological care? Do insured members seek health care differently? Does an education program work differently for the uninsured?

5. Intervention Design Selected 28 sevikas who work where VimoSEWA/LSM active Randomly selected 14 sevikas to implement health education Focus on diarrhea, malaria/fever and hysterectomy Film, games and demonstrations Capacity building and regular feedback Over 2 years, 5 survey rounds amongst insured and uninsured to capture health seeking behavior

6. Study Coverage 70 HH sampled in each cluster 35 uninsured – from area listing 35 insured – from Vimo MIS InsuredUninsuredTotal Urban420396 816 Rural5605581,118 Total9809541,934

7. HH Profile RuralUrban Nuclear Family57%62% HH size5.8 Yrs in current home17 yrs19 yrs Religion93% Hindu 6% Muslim 83% Hindu 16% Muslim HH income (annual)INR 79,260INR 83,337 HH expenditureINR 66,505INR 66,120

8. Education: % ever studied

9. Respondent Profile RuralUrban Age3739 Marital status92% married 7% widowed 83% married 13% widowed Women working 85%61% % SEWA members 53%60% % SEWA Bank13%55%

10. Women’s Work

11. Housing : % HH by Type

12. Household Toilets

13. Drinking Water RuralUrban Own Tap74%78% Shared Tap13%12% Use chlorine27%46% Filter with cloth94%83% Take with doyo22%40%

14. Mosquito precautions

15. Ration Cards/BPL

16. SEWA Health Services

17. VimoSEWA Services

18. VimoSEWA Coverage VimoSEWA reachRuralUrban % of SEWA members8974 % of Bank members7769

19. HH with anyone ill – last month

20. Illness Rates – last month

21. Leading Illnesses - Women

22. Place of OPD Treatment Avg private exp: Rs. 380 Primarily private care, but less so in city Note slight differences within HH Avg private exp: Rs. 501

23. % HH reported hospitalisation in last 6 months

24. Hospitalisation per 100; last 6 mos. Rural and Urban

25. Hospitalisation amongst women Rural Urban

26. Rates: Rural Vimo/Non-insured

27. Rates: Urban Vimo/Non-insured

28. Where Hospitalised - All Rural Urban

29. Place of Hospitalisation

30. Expenditure – Vimo and NV

31. Are VimoSEWA members different? DIFFERENCES SES – only urban More salaried Higher exp More pucca houses Demographic More widows Less educated (urban) Much more likely to have a ration card SIMILARITIES SES Income Toilets Housing (rural) Demographic HH size Family structure

32. Reproductive Health RuralUrban

33. Hysterectomy

34. Age at hysterectomy

35. Hysterectomy Reasons

36. Place of Hysterectomy

37. Analysis Plan Baseline Women’s illnesses and health seeking behaviour Insured and Uninsured Social Determinants of Health Overall Impact of health education – with qualitative Hysterectomy – with qualitative Community health workers – performance and roles